Gynecologic Oncology/Ovarian Carcinoma/Early Stage Cancer (EOC)

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Staging Surgery[edit]

54-year-old with a recent laparoscopic removal of her right ovary by a general OB/GYN. Her final pathology comes back as grade 3 papillary serous carcinoma contained in the ovary. The mass was not ruptured and was removed in a laparoscopic bag. Washings were obtained and were negative. The operative report mentions no evidence of any abnormality was noted on the laparoscopic survey. The patient is otherwise healthy and has recovered from the surgery well.

  • Improved prognostic information: Clear Benefit
  • ACTION trial: N=448 Early ovarian cancer patients after surgery randomized to adjuvant chemotherapy vs observation (See ACTION trial in chemotherapy section for details)
  • 10 years PMID 20445161: More cancer-specific survival (CSS) observed in optimally staged patients compared to non-optimally staged patients 89% vs 69% (SS) in the observation arm. However in chemotherapy arm 85% vs 80% (NS). Therefore, non-optimally staged patients should be restaged or given chemotherapy if restaging is not feasible.
  • Subgroup analysis PMID 21495216: Observation arm of ACTION trial analyzed. Group A (Complete staging) 14.6% recurrences; Group B (all staging steps except LNs) - 34.8% recurrences and Groups C (All staging steps done except blind biopsies of peritoneum) - 35.7% recurrences (SS)
  • Survival Benefit: Unclear
  • Level 1 data: RCT comparing lymphadenectomy (radical/complete/systematic) to lymph node sampling in patients with early ovarian cancer (EOC) PMID 16940979

20-year-old female presents to the emergency room with 15 cm simple cyst. She has been complaining of what seems like history of intermittent torsion. She was taken to the operating room and a single port laparoscopic removal of the ovary is accomplished. During removal the cyst ruptured. Frozen section of the removed tissue reveals mucinous cystadenoma. Patient did well and is discharged from the hospital postoperative day #1. Final pathology revealed high grade mucinous carcinoma. What should be the further management of this patient?